Skip to content

PHARMACY SERVICE INVOLVEMENT IN ANTIMICROBIAL STEWARDSHIP TEAM: STRATEGIES AND RESULTS IN THE MANAGEMENT OF RESPIRATORY TRACT INFECTIONS

European Statement

Clinical Pharmacy Services

Author(s)

Solís-Cuñado S. (1), Sánchez-Cerviño A.C. (2), Martínez-Núñez M.E. (1), Gómez-Bermejo M. (1), Martín-Zaragoza L. (1), Rubio-Ruiz L. (1), Onteniente-González A. (1), Molina-García T. (1)
1. Hospital Pharmacy Service, Getafe University Hospital, Getafe (Madrid), Spain.
2. Hospital Pharmacy Service, Puerta de Hierro University Hospital, Majadahonda (Madrid), Spain.

Why was it done?

The implementation of multidisciplinary antimicrobial stewardship teams(AST) in hospitals optimizes antibiotic use in order to improve clinical results, reduce antibiotic toxicity and minimize the emergence and spread of multidrug resistant(MDR) bacteria.
The objective is to present targeted interventions for the improvement of the management of lower respiratory tract infections(LRTI) and to reflect the impact of these strategies through the presentation of antibiotic use results.

What was done?

Two main interventions have been implemented in LRTI:
-Protocolize the management of community-acquired pneumonia(CAP) in order to prioritize beta-lactam plus macrolide(bLM) combination versus fluoroquinolones(FQ) monotherapy. The aim is to decrease FQ consumption due to their safety issues and the major role of this antibiotics in the emergence of MDR bacteria.
-Identify patients with severe LRTI and/or risk factors of multi-drug resistant(RFMDR) bacterial infections to encourage nasal swab screening(NSS) for meticillin-resistance Staphylococcus aureus(MRSA) to promote de-escalation of anti-MRSA antibiotics.

How was it done?

Study period: 2023 and first semester of 2024.
-CAP guideline: we studied the bLM vs FQ consumption expressed as the ratio between bLM DOT/FQ DOT (Days Of Therapy; DOT) in all hospitalized patients. Analysis was carried out on forth-month period.
-NSS: we reviewed the total number of NSS performed and the impact on duration of antiMRSA antibiotics therapy. Analysis by semesters.

What has been achieved?

After protocolization, the BLM´s DOT/FQ´s DOT ratio increased 39.4% from the beginning of 2023 until 2024: 0.66 vs 0.92.
Our AST reviewed 378 episodes of LRTI. At least one nasal screening was performed in 60.6% of episodes (n=229/378) of which 29.2% were positive (n=67/229). The mean duration of treatment with anti-MRSA antibiotics in the positive cases was 7.42 days, while in the 214 negative cases it was 6.4 days.
69% of the patients with LRTI that have been reviewed in our AST meets at least one RFMDR.

What next?

The frequent lack of diagnostic value of respiratory samples, coupled with the high percentage of RFMDR patients, results in long-lasting broad-spectrum empirical antibiotic treatments.
It is therefore proposed that a polymerase chain reaction(PCR) test be performed on candidate patients for the purpose of screening for MRSA, with a view to obtaining rapid results that will facilitate earlier antibiotic de-escalations.

×

EAHP Forum

All the EAHP team is working on providing a Forum that can help connect all the members in Conversations and Groups to talk about important matters for the European Hospital Pharmacist.

The Forum will be accessible for all the EAHP members, you don’t have to create a new account to browse and participate.

Conversations and groups

The Conversations will be moderated by our team to provide documents and relevant topics for the community.

The Groups will connect all members that share a category. Members who work on the same assocation, on the same hospital, that have the same role, etc.

Stay tuned for the realase of the forum. Soon on EAHP.